I know all the pros and cons of having my ankle fused versus going for a joint replacement. What I really want to know is what kind of results people get years later -- especially if there are problems after surgery. Got any information like that for me?
There are more and more studies all the time comparing ankle fusion to ankle joint replacement. There are studies comparing results from the various implants that are out there now. And there are even some new studies coming out that look at the complication rate after fusion versus joint replacement.
There aren't as many studies that look at the effect of complications and compare them between fusion and joint replacement. But we found one study from the University of British Columbia in Canada that might have the kind of information you are looking for.
They compared two groups of patients with severe, disabling ankle arthritis that did not respond as hoped to conservative care. As you might suspect, one group had the fusion procedure.
The second group received a total ankle replacement (TAR), also known as an ankle arthroplasty. The ankle replacement group did not all get the same type of implant. There were four different implants used. Not everyone had the same surgical approach either. Some patients had open incision surgery while others were treated with arthroscopy.
Besides looking at final function after two years, they also paid attention and compared complications along the way for both groups. X-rays were used to evaluate the joint itself. CT scans added information on the status of the healing process. The Ankle Osteoarthritis Scale (AOS) was used as a measure of pain, function, and disability. Before surgery and postoperative values were recorded for each patient.
Everyone in both groups had significant (and fairly equal) improvements. Pain relief, increased ankle range-of-motion, and improved function (e.g., walking, going up or down stairs, managing uneven terrain) were observed. The complication rate was high for both groups, but twice as high in the ankle arthroplasty group compared with the fusion group.
As it turned out, the affect different complication varied. For example, an implant that had come loose often required a second surgery, whereas even a deep infection could be treated and cleared up with antibiotics.
Anyone in either group with ongoing pain and discomfort from a nerve lesion caused by the surgery was less likely to be satisfied with the long-term results compared with patients who had less significant complications.
The authors concluded that some complications can have significant effects on outcomes in both groups (fusion and joint replacement). Patients receiving a total joint replacement are more likely to have problems. Older, less active adults seem to weather the complications better than younger patients who expect to do more and expect to have fewer problems so are surprised when they have any.
No doubt you will talk with your surgeon about your concerns. Perhaps this information will help you express your concerns clearly and get the kind of information you are looking for. Good luck!
Fabian G. Krause, MD, et al. Impact of Complications in Total Ankle Replacement and Ankle Arthrodesis Analyzed with a Validated Outcome Measurement. In The Journal of Bone and Joint Surgery. May 4, 2011. Vol. 93A. No. 9. Pp. 830-839.
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